|
1
|
Vassilakopoulos TP, Arapaki M, Diamantopoulos PT, Liaskas A, Panitsas F, Siakantaris MP, Dimou M, Kokoris SI, Sachanas S, Belia M, Chatzidimitriou C, Konstantinou EA, Asimakopoulos JV, Petevi K, Boutsikas G, Kanellopoulos A, Piperidou A, Lefaki ME, Georgopoulou A, Kopsaftopoulou A, Zerzi K, Drandakis I, Dimopoulou MN, Kyrtsonis MC, Tsaftaridis P, Plata E, Variamis E, Tsourouflis G, Kontopidou FN, Konstantopoulos K, Pangalis GA, Panayiotidis P, Angelopoulou MK. Prognostic Impact of Serum β 2-Microglobulin Levels in Hodgkin Lymphoma Treated with ABVD or Equivalent Regimens: A Comprehensive Analysis of 915 Patients. Cancers (Basel) 2024; 16:238. [PMID: 38254729 PMCID: PMC10813286 DOI: 10.3390/cancers16020238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024] Open
Abstract
The significance of serum beta-2 microglobulin (sβ2m) in Hodgkin lymphoma (HL) is controversial. We analyzed 915 patients with HL, who were treated with ABVD or equivalent regimens with or without radiotherapy. Sβ2m levels were measured by a radioimmunoassay (upper normal limit 2.4 mg/L). Sequential cutoffs (1.8-3.0 by 0.1 mg/L increments, 3.5 and 4.0 mg/L) were tested along with ROC analysis. The median sβ2m levels were 2.20 mg/L and were elevated (>2.4 mg/L) in 383/915 patients (41.9%). Higher sβ2m was associated with inferior freedom from progression (FFP) at all tested cutoffs. The best cutoff was 2.0 mg/L (10-year FFP 83% vs. 70%, p = 0.001), which performed better than the 2.4 mg/L cutoff ("normal versus high"). In multivariate analysis, sβ2m > 2.0 mg/L was an independent adverse prognostic factor in the whole patient population. In multivariate overall survival analysis, sβ2m levels were predictive at 2.0 mg/L cutoff in the whole patient population and in advanced stages. Similarly, sβ2m > 2.0 mg/L independently predicted inferior HL-specific survival in the whole patient population. Our data suggest that higher sβ2m is an independent predictor of outcome in HL but the optimal cutoff lies within the normal limits (i.e., at 2.0 mg/L) in this predominantly young patient population, performing much better than a "normal versus high" cutoff set at 2.4 mg/L.
Collapse
Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Panagiotis T. Diamantopoulos
- First Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (P.T.D.)
| | - Athanasios Liaskas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Fotios Panitsas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Marina P. Siakantaris
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria Dimou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Styliani I. Kokoris
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Sotirios Sachanas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Marina Belia
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Elianna A. Konstantinou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Kyriaki Petevi
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - George Boutsikas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Alexandros Kanellopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Alexia Piperidou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria-Ekaterini Lefaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Angeliki Georgopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Anastasia Kopsaftopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Kalliopi Zerzi
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Ioannis Drandakis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria N. Dimopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Marie-Christine Kyrtsonis
- First Department of Internal Medicine Propedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece
| | - Panayiotis Tsaftaridis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Eleni Plata
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Eleni Variamis
- First Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (P.T.D.)
| | - Gerassimos Tsourouflis
- Second Department of Surgery Propedeutic, National and Kapodistrian University of Athens, Laikon General Hospital, 11527Athens, Greece
| | - Flora N. Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Ippokration General Hospital, 11527 Athens, Greece;
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Gerassimos A. Pangalis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Panayiotis Panayiotidis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| |
Collapse
|
|
2
|
Vassilakopoulos TP, Kravvariti E, Panitsas F, Angelopoulou MK, Liaskas A, Kontopidou FN, Yiakoumis X, Variami E, Dimopoulou MN, Siakantaris MP, Asimakopoulos JV, Arapaki M, Dimou M, Diamantopoulos P, Sachanas S, Chatzidimitriou C, Belia M, Konstantinou E, Boutsikas G, Petevi K, Kanellopoulos A, Kokoris S, Kyrtsonis MC, Viniou NA, Lakiotaki E, Tsourouflis G, Korkolopoulou P, Konstantopoulos K, Panayiotidis P, Pangalis GA. Very late relapses in Hodgkin lymphoma treated with chemotherapy with or without radiotherapy: linear pattern and distinct prognostic factors. Blood Cancer J 2022; 12:102. [PMID: 35790712 PMCID: PMC9256621 DOI: 10.1038/s41408-022-00674-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022] Open
|
|
3
|
Asimakopoulos JV, Angelopoulou MK, Arapaki M, Kanellopoulos A, Dimou M, Giakoumis X, Konstantinou E, Belia M, Chatzidimitriou C, Sachanas S, Iliakis T, Kyrtsonis M, Siakantaris MP, Viniou N, Variamis E, Kontopidou FN, Pangalis GA, Panayiotidis P, Konstantopoulos K, Vassilakopoulos TP. Validation of the simplified International Prognostic Score3 in a Hellenic cohort of patients with advanced‐stage Hodgkin‐lymphoma. Br J Haematol 2020; 190:e335-e339. [DOI: 10.1111/bjh.16903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/29/2020] [Indexed: 11/26/2022]
Affiliation(s)
- John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Maria‐Panagiota Arapaki
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Alexandros Kanellopoulos
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Maria Dimou
- 1st Propedeutic Department of Internal Medicine National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Xanthoula Giakoumis
- Department of Haematology Athens Medical Center Psychikon Branch Athens Greece
| | - Eliana Konstantinou
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Marina Belia
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Sotirios Sachanas
- Department of Haematology Athens Medical Center Psychikon Branch Athens Greece
| | - Theodoros Iliakis
- 1st Propedeutic Department of Internal Medicine National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Marie‐Christine Kyrtsonis
- 1st Propedeutic Department of Internal Medicine National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Marina P. Siakantaris
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Nora‐Athina Viniou
- 1st Department of Internal Medicine Hematology Unit, National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Eleni Variamis
- 1st Department of Internal Medicine Hematology Unit, National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Flora N. Kontopidou
- Second Department of Internal Medicine National and Kapodistrian University of Athens Hippokration General Hospital Athens Greece
| | | | - Panayiotis Panayiotidis
- 1st Propedeutic Department of Internal Medicine National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| | - Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation Unit National and Kapodistrian University of Athens School of Medicine Laikon General Hospital Athens Greece
| |
Collapse
|
|
4
|
Kanellopoulou T, Alexopoulou A, Kontopidou FN, Konstantinides P, Papatheodoridis GV. The significance of platelet microparticles in patients with chronic hepatitis C and their association with antiviral treatment and smoking. Ann Gastroenterol 2016; 29:201-7. [PMID: 27065733 PMCID: PMC4805741 DOI: 10.20524/aog.2016.0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Platelet microparticles (PMPs) are platelet-derived membrane vesicles involved in cardiovascular diseases and atherosclerosis. Chronic hepatitis C (CHC) is associated with increased atherosclerosis, but the effect of therapy on its atherogenic potential has not been adequately studied. Methods We evaluated PMP levels before and after treatment with pegylated-interferon-alfa and ribavirin in 28 CHC patients compared with 20 non-alcoholic fatty liver disease (NAFLD) patients and 20 healthy volunteers (HV). Results Twenty-four (86%) CHC patients achieved sustained virological response (SVR). PMP levels were determined at baseline in CHC, NAFLD patients, and HV, and at end-of-treatment (EOT) and 24 weeks post-treatment (SVR24) in CHC patients. PMP levels at baseline were higher in CHC than NAFLD patients (P<0.001) and HV (P=0.007). Higher PMPs at baseline were observed in smokers than non-smokers with CHC (P=0.006). Among smokers from all groups, PMPs at baseline were higher in CHC than NAFLD patients (P=0.001) and HV (P=0.024). In CHC patients, PMPs declined from baseline to both EOT (P=0.035) and SVR24 (P=0.006). Only CHC patients with SVR had a significant decline in PMPs from baseline to SVR24 (P=0.018). PMPs at ΕΟΤ and SVR24 in all CHC patients were similar to PMPs in NAFLD patients and HV. Conclusions PMP levels are increased in CHC patients, particularly smokers, which further supports the atherosclerotic potential of CHC and suggests a potentially synergistic effect of smoking and CHC on the atherosclerotic process. Since PMP levels in CHC patients with SVR were similar to NAFLD patients and HV, the atherosclerotic potential of CHC seems to be abolished by effective antiviral treatment.
Collapse
Affiliation(s)
- Theoni Kanellopoulou
- Second Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital (Theoni Kanellopoulou, Alexandra Alexopoulou, Flora N. Kontopidou, Polydoros Konstantinides), Athens, Greece
| | - Alexandra Alexopoulou
- Second Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital (Theoni Kanellopoulou, Alexandra Alexopoulou, Flora N. Kontopidou, Polydoros Konstantinides), Athens, Greece
| | - Flora N Kontopidou
- Second Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital (Theoni Kanellopoulou, Alexandra Alexopoulou, Flora N. Kontopidou, Polydoros Konstantinides), Athens, Greece
| | - Polydoros Konstantinides
- Second Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital (Theoni Kanellopoulou, Alexandra Alexopoulou, Flora N. Kontopidou, Polydoros Konstantinides), Athens, Greece
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital (George V. Papatheodoridis), Athens, Greece
| |
Collapse
|
|
5
|
Kalpadakis C, Pangalis GA, Angelopoulou MK, Sachanas S, Kontopidou FN, Yiakoumis X, Kokoris SI, Dimitriadou EM, Dimopoulou MN, Moschogiannis M, Korkolopoulou P, Kyrtsonis MC, Siakantaris MP, Papadaki T, Tsaftaridis P, Plata E, Papadaki HE, Vassilakopoulos TP. Treatment of splenic marginal zone lymphoma with rituximab monotherapy: progress report and comparison with splenectomy. Oncologist 2013; 18:190-7. [PMID: 23345547 DOI: 10.1634/theoncologist.2012-0251] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Treatment of splenic marginal zone lymphoma (SMZL) patients is not standardized. Recent data suggest that rituximab is highly effective and could be considered as initial therapy. AIM To assess the efficacy of rituximab monotherapy in a large series of patients with SMZL and compare these results with splenectomy results. METHODS The studied population included 85 patients. Fifty-eight received rituximab at a dose of 375 mg/m2 per week for 6 weeks as induction followed by maintenance at the same dose every 2 months for 1-2 years, whereas 27 patients were treated using splenectomy only. RESULTS The overall response rate to rituximab 2 months after the end of induction was 95% (complete response [CR], 45%; unconfirmed CR, 26%; partial response, 24%). The median times to hematologic and clinical response were 2 weeks and 3 weeks, respectively. Forty-three of 55 patients already completed the maintenance phase: 28 sustained their initial response, 14 improved their response, and one progressed. Eighty-five percent of splenectomized patients responded, and two were treated with rituximab as consolidation after splenectomy and achieved a CR. The 5-year overall and progression-free survival (PFS) rates for rituximab-treated and splenectomized patients were 92% and 77% (p = .09) and 73% and 58% (p = .06), respectively. Furthermore, maintenance therapy with rituximab resulted in a longer duration of response (at 5 years, PFS was 84% for patients receiving maintenance and 36% for patients without maintenance, p <.0001). CONCLUSIONS Rituximab is a very effective and well-tolerated therapy and may be substituted for splenectomy as the first-line treatment of choice for patients with SMZL.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Disease-Free Survival
- Female
- Humans
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Male
- Middle Aged
- Retrospective Studies
- Rituximab
- Splenectomy/adverse effects
- Splenectomy/methods
- Splenic Neoplasms/drug therapy
- Splenic Neoplasms/pathology
- Splenic Neoplasms/surgery
- Treatment Outcome
Collapse
Affiliation(s)
- Christina Kalpadakis
- Department of Haematology, University Hospital of Heraklion, P.O. Box 1352, Heraklion, Crete, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
6
|
Kanellopoulou T, Kontopidou FN, Skondra M, Pliarchopoulou K, Pectasides D. Chronic myelogenous leukemia and colon cancer: A causal relationship or coincidence? Ann Gastroenterol 2011; 24:140-141. [PMID: 24713727 PMCID: PMC3959299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 03/08/2011] [Indexed: 10/27/2022] Open
Affiliation(s)
- Theoni Kanellopoulou
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece,
Correspondence to: Kanellopoulou Theoni, MD, 48, Satovriandou str. 124-62 Haidari, Greece; Tel. : +30-2107774742; Fax: +30-2107706871; e-mail:
| | - Flora N. Kontopidou
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Maria Skondra
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Kyriaki Pliarchopoulou
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Pectasides
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece
| |
Collapse
|
|
7
|
Kanellopoulou T, Alexopoulou A, Kontopidou FN, Filiotou A. Development of non-Hodgkin's lymphoma in a patient with primary biliary cirrhosis: A case report and review of the literature. Ann Gastroenterol 2011; 24:125-128. [PMID: 24713720 PMCID: PMC3959296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 02/15/2011] [Indexed: 10/31/2022] Open
Abstract
Patients with autoimmune disorders seem to have an elevated risk of lymphoma, especially non-Hodgkin's lymphoma (NHL). The increased risk has been attributed to the disturbance of immune function found in these patients or to the immunosuppressive therapy used to treat the autoimmune disorders. However, little information exists about the estimated baseline risk for lymphoma in patients with primary biliary cirrhosis (PBC). In this case report, we describe a female patient who developed nodal diffuse large B-cell lymphoma ten years following PBC diagnosis. Twenty five additional case reports (19 NHL and 4 Hodgkin's disease (HD), 2 without data about NHL or Hodgkin's disease) predominantly females were identified in the English literature. B-cell lymphoma was the most common NHL type reported but beyond that no clear predisposition for any specific lymphoma subtype was documented. PBC usually preceded lymphoma diagnosis. Fifteen cases had extranodal localization and the most common site was the liver.
Collapse
Affiliation(s)
- Theoni Kanellopoulou
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Alexandra Alexopoulou
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece,
Correspondence to: Alexandra Alexopoulou, Lecturer in Medicine, 40 Konstantinoupoleos Str, 16342 Athens, Greece; tel. +302107774742; fax: +30 2107706871;
| | - Flora N. Kontopidou
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Anna Filiotou
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece
| |
Collapse
|
|
8
|
Sachanas S, Pangalis GA, Vassilakopoulos TP, Korkolopoulou P, Kontopidou FN, Athanasoulia M, Yiakoumis X, Kalpadakis C, Georgiou G, Masouridis S, Moschogiannis M, Tsirkinidis P, Pappis V, Kokoris SI, Siakantaris MP, Panayiotidis P, Angelopoulou MK. Combination of rituximab with chlorambucil as first line treatment in patients with mantle cell lymphoma: a highly effective regimen. Leuk Lymphoma 2010; 52:387-93. [DOI: 10.3109/10428194.2010.534518] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
|
9
|
Tsagarakis NJ, Kentrou NA, Papadimitriou KA, Pagoni M, Kokkini G, Papadaki H, Pappa V, Marinakis T, Anagnostopoulos NI, Vadikolia C, Anagnostopoulos A, Angelopoulou MK, Terpos E, Poziopoulos C, Anargyrou K, Rontogianni D, Papadaki T, Psarra A, Kontopidou FN, Skoumi D, Papadhimitriou SI, Paterakis G. Acute lymphoplasmacytoid dendritic cell (DC2) leukemia: Results from the Hellenic Dendritic Cell Leukemia Study Group. Leuk Res 2010; 34:438-46. [DOI: 10.1016/j.leukres.2009.09.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 09/05/2009] [Accepted: 09/05/2009] [Indexed: 01/29/2023]
|
|
10
|
Yiakoumis X, Pangalis GA, Kyrtsonis MC, Vassilakopoulos TP, Kontopidou FN, Kalpadakis C, Korkolopoulou P, Levidou G, Androulaki A, Siakantaris MP, Sachanas S, Andreopoulos A. Primary effusion lymphoma in two HIV-negative patients successfully treated with pleurodesis as first-line therapy. Anticancer Res 2010; 30:271-276. [PMID: 20150647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Primary effusion lymphoma (PEL) is a rare non-Hodgkin's lymphoma (NHL) mostly occurring in HIV-positive patients. It is characterized by the development of effusion in one or more body cavities, with no tumor masses and a positive human herpes virus-8 (HHV8) status. It has a poor survival profile and no optimal treatment is yet defined. We report two HIV-negative, HHV8-positive patients with PEL of the pleural cavity who achieved a durable remission after pleurodesis with bleomycin and no systemic therapy. We also perform a review of the relevant literature regarding the clinical data, treatment, and survival of PEL in HIV-negative patients.
Collapse
Affiliation(s)
- X Yiakoumis
- Department of Haematology, Iatriko Athinon, Psychicon Branch, 1st Kyriakidou Str, P. Psychikon, 15452 Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
11
|
Kokoris SI, Siakantaris MP, Kontopidou FN, Kyrtsonis MC, Tsakris A, Spanakis N, Anargyrou K, Vassilakopoulos TP, Viniou NA, Korkolopoulou P, Dimitrakopoulou AD, Legakis N, Pangalis GA. Adult T-Cell Leukemia/Lymphoma (ATLL): Report of Two Fully Documented Hellenic Patients. Leuk Lymphoma 2009; 45:715-21. [PMID: 15160945 DOI: 10.1080/1042819032000140960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
ATLL is etiologically associated with HTLV-I retrovirus. A population of 10 to 20 million worldwide is estimated to be infected by the virus, but only 1-4% develop ATLL during a 70-year lifespan. The latency period is more than 30 years. The aim of this study was to report two cases of ATLL in Greek patients with the concomitant study of their family members. A 55-year-old woman and a 59-year-old man presented with leucocytosis and lymphocytosis. Both were asymptomatic and physical examination was unremarkable except for minimal lymphadenopathy in the second patient. In both patients blood smears showed small-to-medium-sized, multilobulated lymphocytes, with different degrees of nuclear irregularity. Immunophenotypic study was as follows: CD2 + (97%), CD3 + (95%), CD5 + (95%), CD3/CD4 + (93%), CD3/CD25 + (84%), CD7 -/CD4 + (89%) CD2 + /HLA-DR + (53%), TCRabeta + (96%) and CD7-(7%). Bone marrow biopsy revealed a normal cellularity with dyserythropoiesis and scattered small lymphocytes (CD4 + on immunostaining) Serum HTLV I and II antibodies were positive. T-cell receptor gamma-chain rearrangement was positive in blood lymphocytes by PCR. Cytogenetic analysis showed complex karyotypic abnormalities. DNA analysis by PCR demonstrated the integration of the HTLV-I DNA in the DNA of the neoplastic T cells. Both patients rapidly developed acute type ATLL. In the first patient multiple subcutaneous nodules on the palmar surface of both hands were also observed. She received deoxycoformycin, which was stopped because of autoimmune hemolytic anemia. Corticosteroid treatment was initiated, with gradual improvement. She suffered from recurrent opportunistic infections. She is currently under interferon and zidovudine therapy with stable blood parameters. Chemotherapy was administered to the other patient with > 50% initial response. Both patients' families were tested for serum anti HTLV-I antibodies and their mates were found to be positive; they also had detectable viral DNA by PCR analysis while asymptomatic, with no abnormal clinical findings and normal white blood cell count and morphology. In conclusion, the two aforementioned patients are the first fully documented ATLL patients described in Greece. Investigation for HTLV-I antibodies should be mandatory in all patients with T-cell lymphoproliferative disorders.
Collapse
Affiliation(s)
- Styliani I Kokoris
- Haematology Section, 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital of Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
12
|
Kalpadakis C, Pangalis GA, Vassilakopoulos TP, Kyrtsonis MC, Siakantaris MP, Kontopidou FN, Korkolopoulou P, Bobotsis P, Sahanas S, Tzenou T, Anagnostou D, Dimitriadou E, Yiakoumis X, Patsouris E, Roussou P, Panayiotidis P, Papadaki E, Angelopoulou MK. Non-gastric extra-nodal marginal zone lymphomas–a single centre experience on 76 patients. Leuk Lymphoma 2009; 49:2308-15. [DOI: 10.1080/10428190802510331] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
|
13
|
Siakantaris MP, Pangalis GA, Dimitriadou E, Kontopidou FN, Vassilakopoulos TP, Kalpadakis C, Sachanas S, Yiakoumis X, Korkolopoulou P, Kyrtsonis MC, Bobotsis P, Androulaki A, Patsouris E, Panayiotidis P, Angelopoulou MK. Early-stage gastric MALT lymphoma: is it a truly localized disease? Oncologist 2009; 14:148-54. [PMID: 19204322 DOI: 10.1634/theoncologist.2008-0178] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Early-stage gastric mucosa-associated lymphoid tissue lymphoma (GML) is considered a localized disease with an indolent course. Circulating malignant cells have been detected in other early-stage indolent lymphomas by molecular methods. We investigated the incidence of occult blood disease in early-stage GML patients, its impact on clinical outcome, and the similarity between blood and gastric lymphocytic clones. Sixty-two patients with localized GML were included in the study; 51 of them had Helicobacter pylori infection. Monoclonality was investigated by leader polymerase chain reaction. Sequencing was performed for the immunoglobulin variable gene (VH) analysis. Blood involvement was absent in all patients by conventional staging methods. In the whole group of 62 patients, the incidence of blood IgH rearrangement was 45%, and this did not correlate with baseline patient characteristics. The monoclonal blood and gastric products of five patients were sequenced and compared with each other. Clonal identity was evident in four of five patients. The VH3 gene was the most frequently used, both in the blood and in the stomach. Early-stage GML is not a truly localized disease because half the patients had a circulating clone, probably identical to the gastric one. The clinical significance of occult blood disease and the potential appropriate intervention need to be further investigated.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- B-Lymphocytes/pathology
- Female
- Helicobacter Infections/blood
- Helicobacter Infections/drug therapy
- Helicobacter Infections/pathology
- Humans
- Immunoglobulin Heavy Chains/blood
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Immunophenotyping
- Lymphoma, B-Cell, Marginal Zone/blood
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/virology
- Male
- Middle Aged
- Neoplasm Staging
- Polymerase Chain Reaction
- Sequence Analysis, DNA
- Stomach Neoplasms/blood
- Stomach Neoplasms/genetics
- Stomach Neoplasms/pathology
- Stomach Neoplasms/virology
- Treatment Outcome
Collapse
Affiliation(s)
- Marina P Siakantaris
- Department of Haematology, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
14
|
Kalpadakis C, Pangalis GA, Dimopoulou MN, Vassilakopoulos TP, Kyrtsonis MC, Korkolopoulou P, Kontopidou FN, Siakantaris MP, Dimitriadou EM, Kokoris SI, Tsaftaridis P, Plata E, Angelopoulou MK. Rituximab monotherapy is highly effective in splenic marginal zone lymphoma. Hematol Oncol 2007; 25:127-31. [PMID: 17514771 DOI: 10.1002/hon.820] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Splenectomy has traditionally been considered as a standard first line treatment for splenic marginal zone lymphoma (SMZL) conferring a survival advantage over chemotherapy. However it carries significant complications, especially in elderly patients. The purpose of this retrospective study was to report our experience on the efficacy of Rituximab as first line treatment in 16 consecutive SMZL patients, diagnosed in our department. The diagnosis was established using standard criteria. Patients' median age was 57 years (range, 48-78). Prior to treatment initiation all patients had splenomegaly, nine had anemia, five lymphocytosis, five neutropenia and six thrombocytopenia. Rituximab was administered at a dose of 375 mg/m2/week for 6 consecutive weeks. The overall response rate was 100%. After treatment, all patients had a complete resolution of splenomegaly along with restoration of their blood counts. Eleven patients (69%) achieved a CR, three (19%) unconfirmed CR and two (12%) a PR. Among the complete responders seven patients had also a molecular remission. The median time to clinical response was 3 weeks (range, 2-6). Rituximab maintenance was given to 12 patients. Eleven of them had no evidence of disease progression after a median follow-up time of 28.5 months (range, 14-36), while two out of four patients who did not receive maintenance, relapsed 7 and 24 months after the completion of induction treatment. Median follow-up time for the entire series was 29.5 months (range, 15-81). No deaths were recorded during the follow-up period. Therapy was well tolerated. The present study demonstrates that rituximab is an effective treatment for SMZL and could be considered as a substitute or alternative to splenectomy.
Collapse
Affiliation(s)
- C Kalpadakis
- First Department of Internal Medicine, National Kapodistrian University of Athens, Laikon University Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
15
|
Kyrtsonis MC, Siakantaris MP, Kalpadakis C, Dimopoulou MN, Vassilakopoulos TP, Kontopidou FN, Antoniou C, Korkolopoulou P, Panayiotidis P, Pangalis GA. Favorable outcome of primary cutaneous marginal zone lymphoma treated with intralesional rituximab. Eur J Haematol 2006; 77:300-3. [PMID: 16856917 DOI: 10.1111/j.1600-0609.2006.00720.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Primary cutaneous marginal zone lymphoma (PCMZL) is an indolent disease. Treatment options include excision, local irradiation, interferon-alpha or chemotherapy. We present two patients with PCMZL and multiple skin lesions successfully treated with intralesional administration of the anti-CD20 monoclonal antibody rituximab. The first presented with four red skin lesions and the second with two. Biopsy of the largest lesion revealed marginal zone B-cell lymphoma in both patients. There was no evidence of systemic involvement in either patient. Both patients were treated with intralesional rituximab for 18 consecutive weeks. Skin lesions gradually regressed. Apart from mild local pain during the injection, no other adverse effects were observed. In conclusion, rituximab can be safely administered intralesionally in patients with PCMZL and can produce disease remission.
Collapse
Affiliation(s)
- Maria-Christina Kyrtsonis
- First Department of Internal Medicine and Department of Haematology, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
16
|
Pangalis GA, Kyrtsonis MC, Vassilakopoulos TP, Dimopoulou MN, Siakantaris MP, Emmanouilides C, Doufexis D, Sahanas S, Kontopidou FN, Kalpadakis C, Angelopoulou MK, Dimitriadou EM, Kokoris SI, Panayiotidis P. Immunotherapeutic and Immunoregulatory Drugs in Haematologic Malignancies. Curr Top Med Chem 2006; 6:1657-86. [PMID: 17017950 DOI: 10.2174/156802606778194235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A better understanding of the biology and pathogenesis of hematological malignancies has led to the development of immunotherapeutic and immunoregulatory drugs. Many of these agents have revolutionized the current treatment modalities, while others are under investigation. Rituximab (anti-CD20 antibody) has been established as the gold standard of treatment for aggressive B-cell lymphomas in combination with CHOP and has shown significant activity as monotherapy in the treatment of indolent B-cell lymphomas. In follicular lymphomas the combination of Rituximab with chemotherapy improves the outcome compared to chemotherapy alone. CD 20-based radioimmunotherapy, with the advantage of the bystander effect, represents an additional therapeutic alternative in B-cell lymphomas and may produce tumor regression in Rituximab resistant patients. The anti-CD52 monoclonal antibody, alemtuzumab, further expands the armamentarium against lymphoid malignancies producing high response rates in these entities. Antibody-targeted chemotherapy such as gemtuzumab ozogamicin, consisting of an anti-CD33 antibody combined to calicheamicin, has shown efficacy in the treatment of refractory acute myeloid leukemia; exact indications, timing and dosing schedule for optimized efficacy remain to be determined. Interferons have proven significant activity in cutaneous lymphomas, hairy cell leukemia and chronic myelogenous leukemia by mechanisms that are not fully elucidated. Thalidomide, by acting as an immunomodulatory and antiangiogenic agent can modulate neoplastic cells microenvironment and lead to disease control in multiple myeloma as well as in numerous other hematological malignancies. Bortezomib, a proteasome inhibitor, displays significant anti-tumor activity, especially in multiple myeloma and lymphoproliferative disorders. The addition of these agents in therapeutic regimens has improved considerably the treatment of hematological malignancies.
Collapse
Affiliation(s)
- Gerassimos A Pangalis
- First Department of Internal Medicine, First Department of Propedeutic Internal Medicine & Department of Hematology, National and Kapodistrian University of Athens Medical School, Laikon General Hospital, Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Vassilakopoulos TP, Kyrtsonis MC, Papadogiannis A, Nadali G, Angelopoulou MK, Tzenou T, Dimopoulou MN, Siakantaris MP, Kontopidou FN, Kalpadakis C, Kokoris SI, Dimitriadou EM, Tsaftaridis P, Pizzolo G, Pangalis GA. Serum levels of soluble syndecan-1 in Hodgkin's lymphoma. Anticancer Res 2005; 25:4743-6. [PMID: 16334170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Syndecan-1 (CD138) is expressed by the Hodgkin-Reed-Sternberg (HRS) cells of classic Hodgkin's lymphoma (cHL), but not in nodular lymphocyte-predominant HL. Syndecan-1 may be involved in the interaction between HRS cells and the cellular and stromal microenvironment typical of nodular sclerosing HL. PATIENTS AND METHODS Serum levels of soluble syndecan-1 were determined by ELISA in 66 patients with HL and 14 age- and sex-matched healthy individuals. RESULTS The levels of syndecan-1 were higher in HL patients than controls (100.2 +/- 35.9 ng/ml vs. 67.9 +/- 24.5 ng/ml, p < 0.001). They marginally correlated with advanced age (p = 0.06), male gender (p = 0.07) and consequently high IPS (p = 0.01), but did not correlate with markers of tumor burden and prognosis, including serum interleukin-10 and soluble CD30. At 6 years, failure-free survival was 70 +/- 9% vs. 50 +/- 11% (p = 0.32) for patients with serum soluble syndecan-1 levels above or below the observed median value of 91 ng/ml. CONCLUSION The serum levels of syndecan-1 were elevated in patients with HL, but were not strongly correlated with other potential prognostic factors. Their effect on prognosis deserves further evaluation.
Collapse
Affiliation(s)
- Theodoros P Vassilakopoulos
- First Department of Internal Medicine and Department of Haematology, National and Kapodistrian University of Athens, Laikon University Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
18
|
Pangalis GA, Kyrtsonis MC, Kontopidou FN, Siakantaris MP, Dimopoulou MN, Vassilakopoulos TP, Tzenou T, Kokoris S, Dimitriadou E, Kalpadakis C, Tsalimalma K, Tsaftaridis P, Panayiotidis P, Angelopoulou MK. Differential Diagnosis of Waldenström's Macroglobulinemia and Other B-Cell Disorders. ACTA ACUST UNITED AC 2005; 5:235-40. [PMID: 15794855 DOI: 10.3816/clm.2005.n.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Waldenstrom's macroglobulinemia (WM) is characterized by lymphoplasmacytic infiltration of bone marrow and/or other tissues and by the presence of serum monoclonal immunoglobulin M ([IgM], without cutoff limit). Differential diagnosis from other B-cell disorders (BCDs) is usually easy based on clinical, morphologic, histopathologic, immunophenotypic, and genetic features. However, all BCDs potentially produce monoclonal IgM. In this study we reviewed the medical files of 130 patients with IgM-secreting BCDs. Eighty-four patients were diagnosed with WM, 5 with IgM-monoclonal gammopathy of undetermined significance (MGUS), and 41 with other BCDs (9 with B-cell chronic lymphocytic leukemia, 5 with small lymphocytic lymphoma, 14 with marginal zone lymphoma, 5 with mantle-cell lymphoma, 2 with follicular lymphoma, 2 with diffuse large B-cell lymphoma, 2 with cryoglobulinemia, and 2 with low-grade lymphoma not otherwise specified). Median IgM levels were 3215 mg/dL in WM, 840 mg/dL in IgM-MGUS, and 285 mg/dL in other BCDs (5 had IgM levels > 1500 mg/dL). In 10% of non-WM BCDs, monoclonal IgM was found only when more sensitive immunofixation methods were used. Forty-four percent of patients with BCDs (splenic marginal zone lymphoma or small lymphocytic lymphoma) had diagnoses that corresponded to that of WM. Careful diagnosis requires the concomitant evaluation of all parameters of BCDs together. Marginal zone lymphoma is the most frequently overlapping entity. Special attention should be given to mantle cell lymphoma in its atypical forms. Research in this field should continue to further clarify the disease entities that overlap with WM. New technology such as gene-expression profile techniques may contribute to this purpose.
Collapse
Affiliation(s)
- Gerassimos A Pangalis
- First Department of Internal Medicine and Department of Hematology, National and Kapodistrian University of Athens, Laikon General Hospital, 16 Sevastoupoleos Street, Athens 11526, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
19
|
Vassilakopoulos TP, Nadali G, Angelopoulou MK, Dimopoulou MN, Siakantaris MP, Kontopidou FN, Karkantaris C, Kokoris SI, Dimitriadou EM, Calpadaki C, Sarantopoulos A, Galani Z, Sachanas S, Kyrtsonis MC, Tsaftaridis P, Variamis E, Panayotidis P, Pizzolo G, Sarris AH, Pangalis GA. beta(2)-microglobulin in Hodgkin's lymphoma: prognostic significance in patients treated with ABVD or equivalent regimens. J BUON 2005; 10:59-69. [PMID: 17335133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Serum beta-2 microglobulin (sbeta(2)m) is an established prognostic factor for several lymphoproliferative disorders. Because its significance in Hodgkin's lymphoma (HL) is controversial, we determined sbeta(2)m levels in pretreatment serum samples of patients with HL in order to elucidate its prognostic value in this condition. PATIENTS AND METHODS Pretreatment sbeta(2)m levels were determined in 379 HL patients who were treated with ABVD or equivalent regimens with or without radiotherapy (RT), using a radioimmunoassay (upper normal limit 2.4 mg/l). Sbeta(2)m levels were correlated with several clinical and laboratory parameters. RESULTS Elevated sbeta(2)m levels were detected in 138/379 (36%) patients and correlated with all clinical and laboratory baseline features except gender, lung involvement and mediastinal bulk. They also correlated with serum soluble CD30 and interleukin-10 levels. The 8-year failure-free survival (FFS) was 78 -/+ 4% for patients with normal versus 65 -/+ 7% for patients with elevated sbeta(2)m levels (p=0.003). The corresponding rates among early-stage patients were 83 -/+ 53% versus 71 -/+ 9% (p=0.003), while for advanced stages they were 70 -/+ 6% versus 64 -/+ 8% (p=0.54). In multivariate analysis of the whole patient population elevation of sbeta(2)m levels was not predictive of FFS, but it was strongly predictive among early-stage patients. The 8-year overall survival (OS) rates were 91 -/+ 3% for patients with normal versus 59 -/+ 11% (p <0,0001) for patients with elevated sbeta(2)m levels, while unrelated mortality at 8 years was 1 -/+ 1% versus 27 -/+ 12% (p<0.0001). CONCLUSION Our data suggest that sbeta(2)m levels may be a potent prognostic factor for FFS in patients with early stage HL treated with ABVD and equivalent regimens. Their effect on OS is confounded by the higher unrelated mortality in patients with elevated baseline sbeta(2)m levels, probably due to the strong association between sbeta(2)m and older age.
Collapse
Affiliation(s)
- T P Vassilakopoulos
- Hematology Section, First Department of Internal Medicine, National and Kapodistrian University of Athens, "Laikon" General Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
20
|
Vassilakopoulos TP, Angelopoulou MK, Siakantaris MP, Kontopidou FN, Dimopoulou MN, Kokoris SI, Kyrtsonis MC, Tsaftaridis P, Karkantaris C, Anargyrou K, Boutsis DE, Variamis E, Michalopoulos T, Boussiotis VA, Panayiotidis P, Papavassiliou C, Pangalis GA. Combination chemotherapy plus low-dose involved-field radiotherapy for early clinical stage Hodgkin's lymphoma. Int J Radiat Oncol Biol Phys 2004; 59:765-81. [PMID: 15183480 DOI: 10.1016/j.ijrobp.2003.11.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Revised: 09/24/2003] [Accepted: 11/12/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To present our long-term experience regarding the use of chemotherapy plus low-dose involved-field radiotherapy (IFRT) for clinical Stage I-IIA Hodgkin's lymphoma. METHODS AND MATERIALS We analyzed the data of 368 patients. Of these, 66 received mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and 302 received doxorubicin (or epirubicin), bleomycin, vinblastine, and dacarbazine [A(E)BVD]. Patients with complete remission or very good partial remission were scheduled for low-dose IFRT (< or =3200 cGy). RESULTS The 10-year failure-free survival (FFS) and overall survival (OS) rate was 85% and 86%, respectively. A(E)BVD-treated patients had superior 10-year FFS and OS rates compared with MOPP-treated patients (87% vs. 75%, p = 0.009; and 93% vs. 71%, p = 0.0004, respectively). Only 10 of 41 relapses had any infield (irradiated) component. Of the complete responders/very good partial responders treated with low-dose IFRT, those who received <2800 cGy had inferior FFS but similar OS as those who received 2800-3200 cGy. Adverse prognostic factors for FFS included age > or =45 years, leukocytosis > or =10 x 10(9)/L, and extranodal extension. Secondary acute leukemia developed after MOPP with or without salvage therapy (n = 6) or after ABVD plus salvage therapy (n = 2). None of the nine secondary solid tumors developed within the RT fields. CONCLUSION IFRT at a dose of 2800-3000 cGy is highly effective in clinical Stage I-IIA HL patients who achieved a complete response or very good partial response with A(E)BVD. The long-term toxicity with respect to secondary malignancies appears to be acceptable.
Collapse
Affiliation(s)
- Theodoros P Vassilakopoulos
- Haematology Section, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
21
|
Pangalis GA, Kyrtsonis MC, Kontopidou FN, Vassilakopoulos TP, Siakantaris MP, Dimopoulou MN, Kittas C, Angelopoulou MK. Differential diagnosis of Waldenstrom's macroglobulinemia from other low-grade B-cell lymphoproliferative disorders. Semin Oncol 2003; 30:201-5. [PMID: 12720136 DOI: 10.1053/sonc.2003.50046] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Waldenstrom's macroglobulinemia (WM) is a rare lymphoproliferative disorder (LPD) characterized by lymphoplasmacytic infiltration of the bone marrow (BM) and/or occasionally other tissues and by the presence of a serum monoclonal IgM. The disease belongs to the lymphoplasmacytic lymphoma (LPL) subtype. Whether WM is indeed a separate entity or is merely an IgM-secreting subtype of low-grade B-cell lymphoma is still controversial. In our series of 67 patients, WM has a long median overall survival of 110 months, and the male/female ratio is 1.2/1. Clinical features include a wide spectrum of manifestations, many of which may be common to other LPDs. Differential diagnosis is based on: (1) clinical and laboratory features (anemia, organomegaly, lymphadenopathy, IgM paraproteinemia), (2) cell morphology (lymphocytes, lymphoplasmacytes, few plasma cells), (3) histopathology of bone marrow or lymph node, (4) immunophenotype (CD5 expression and the intensity of CD5, CD20, and CD79b antigens may help in discrimination from other LPDs and atypical CLL), and (5) characteristic genetic features (present in other LPDs). Based on the former, diagnosis is usually easy. It may be harder in LPL cases not secreting IgM. We consider that WM should be, for the time being, handled as a separate entity. Further studies are necessary.
Collapse
Affiliation(s)
- Gerassimos A Pangalis
- Haematology Section, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
|
22
|
Pangalis GA, Vassilakopoulos TP, Dimopoulou MN, Siakantaris MP, Kontopidou FN, Angelopoulou MK. B-chronic lymphocytic leukemia: practical aspects. Hematol Oncol 2002; 20:103-46. [PMID: 12203655 DOI: 10.1002/hon.696] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
B-CLL is the most common adult leukemia in the Western world. It is a neoplasia of mature looking B-monoclonal lymphocytes co-expressing the CD5 antigen (involving the blood, the bone marrow, the lymph nodes and related organs). Much new information about the nature of the neoplastic cells, including chromosomal and molecular changes as well as mechanisms participating in the survival of the leukemic clone have been published recently, in an attempt to elucidate the biology of the disease and identify prognostic subgroups. For the time being, clinical stage based on Rai and Binet staging systems remains the strongest predictor of prognosis and patients' survival, and therefore it affects treatment decisions. In the early stages treatment may be delayed until progression. When treatment is necessary according to well-established criteria, there are nowadays many different options. Chlorambucil has been the standard regimen for many years. During the last decade novel modalities have been tried with the emphasis on fludarabine and 2-chlorodeoxyadenosine and their combinations with other drugs. Such an approach offers greater probability of a durable complete remission but no effect on overall survival has been clearly proven so far. Other modalities, included in the therapeutic armamentarium, are monoclonal antibodies, stem cell transplantation (autologous or allogeneic) and new experimental drugs. Supportive care is an important part of patient management and it involves restoring hypogammaglobulinemia and disease-related anemia by polyvalent immunoglobulin administration and erythropoietin respectively.
Collapse
Affiliation(s)
- Gerassimos A Pangalis
- Hematology Section, 1st Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
|
23
|
Vassilakopoulos TP, Nadali G, Angelopoulou MK, Siakantaris MP, Dimopoulou MN, Kontopidou FN, Karkantaris C, Kokoris SI, Kyrtsonis MC, Tsaftaridis P, Pizzolo G, Pangalis GA. The prognostic significance of beta(2)-microglobulin in patients with Hodgkin's lymphoma. Haematologica 2002; 87:701-8; discussion 708. [PMID: 12091120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Serum beta(2)-microglobulin (s beta(2)m) is an established prognostic factor for multiple myeloma and non-Hodgkin's lymphoma, but only limited data suggest an adverse prognostic significance for Hodgkin's lymphoma (HL). This study was undertaken to examine the impact of s beta(2)m on the prognosis of patients with HL. DESIGN AND METHODS s beta(2)m was measured by a radioimmunoassay (upper normal limit 2.4 mg/L), in pretreatment serum samples of 232 patients with HL, who were then treated with ABVD or equivalent regimens with or without radiotherapy. Multivariate survival analysis was based on Cox's proportional hazards model. RESULTS Main patients' characteristics: median age 30.5 years (14-78); 58% males; 68% nodular sclerosis, 20% mixed cellularity and 12% lymphocyte predominance; 34% B-symptoms; 24% Ann Arbor stage I, 49% II, 18% III and 9% IV. Elevated s beta(2)m levels were detected in 65/232 patients (28%) and correlated with older age (p<0.001), mixed cellularity (p=0.03), B-symptoms (p=0.002), advanced stage (p=0.02), > or = 5 involved sites (p=0.02), inguinal/iliac involvement (p=0.009), lymphocytopenia (p=0.002) and elevated lactate dehydrogenase (p=0.01). The 7-year failure free survival (FFS) was 75% vs. 72% for patients with normal vs. elevated s beta(2)m (p=0.15). The corresponding 7-year overall survival (OS) rates were 86% vs. 52% (p=0.003). In multivariate analysis, elevated s beta(2)m was not predictive of FFS, but was independently associated with inferior OS (p=0.01), along with the number of involved sites (p<0.001). INTERPRETATION AND CONCLUSIONS s beta(2)m is not a potent prognostic factor for FFS in optimally treated patients with HL. However s beta(2)m may be predictive of OS, probably due to its effect on the timing of treatment failure.
Collapse
Affiliation(s)
- Theodoros P Vassilakopoulos
- Hematology Section, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
24
|
Pangalis GA, Siakantaris MP, Angelopoulou MK, Vassilakopoulos TP, Dimopoulou MN, Kyrtsonis MC, Konstantopoulos K, Tsaftaridis P, Vaiopoulos GA, Kontopidou FN. Downstaging Rai stage III B-chronic lymphocytic leukemia patients with the administration of recombinant human erythropoietin. Haematologica 2002; 87:500-6. [PMID: 12010663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the effectiveness of recombinant human erythropoietin (r-HuEPO) on disease-related anemia in patients with B-chronic lymphocytic leukemia (B-CLL) and to explore whether improvement of anemia could delay the initiation of cytotoxic therapy. DESIGN AND METHODS Twenty five B-CLL patients (12 males and 13 females; median age 70 years) with disease-related anemia were treated with r-HuEPO. Patients were either on no treatment or on a standard regimen, and had at least Rai stage III disease, with a hematocrit (Hct) <32%. Eleven were newly diagnosed, whereas 14 developed anemia during follow-up. Treatment induction lasted for a maximum of 3 months, during which patients were receiving 150 IU/kg of r-HuEPO s.c. t.i.w. with an escalation to 300 IU/kg t.i.w. if response was slow after one month. Responding patients were placed on maintenance r-HuEPO with 150 IU/kg s.c. once weekly, continuously. Complete response (CR) was defined as an increase of Hct to 38% or more and partial response (PR) as an increase of >6% from pretreatment level. RESULTS CR was observed in 18/25 (72%) and PR in 2/25 (8%) of the patients. Six patients were downstaged to stage Rai 0, 9 to Rai I and 4 to Rai II. Response was sustained with maintenance therapy. At a median follow-up of 32 months only 4 of the responders required antileukemic treatment. The median survival of responders has not been reached, and 3-year survival is 84%. INTERPRETATION AND CONCLUSIONS r-HuEPO was efficient in downstaging Rai stage III B-CLL patients, and delayed the initiation of antileukemic therapy. Whether this effect can be translated into better survival rates remains to be clarified in randomized trials.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Anemia/drug therapy
- Anemia/etiology
- Erythropoietin/administration & dosage
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Recombinant Proteins
- Remission Induction
- Treatment Outcome
Collapse
Affiliation(s)
- Gerassimos A Pangalis
- National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 16 Sevastoupoleos St., P.O. Box 14044, Athens 11510, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
25
|
Vassilakopoulos TP, Angelopoulou MK, Siakantaris MP, Kontopidou FN, Dimopoulou MN, Boutsis DE, Anargyrou K, Kokoris SI, Giannakakis A, Karkantaris C, Kyrtsonis MC, Tsaftaridis P, Rombos J, Variamis E, Korkolopoulou P, Kittas C, Pangalis GA. Hodgkin's lymphoma in first relapse following chemotherapy or combined modality therapy: analysis of outcome and prognostic factors after conventional salvage therapy. Eur J Haematol 2002; 68:289-98. [PMID: 12144535 DOI: 10.1034/j.1600-0609.2002.01721.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the prognosis of patients with Hodgkin's lymphoma (HL) who relapse following a complete remission (CR) achieved by chemotherapy with or without radiotherapy (CT+/-RT), and to identify prognostic factors for freedom from second progression (FF2P). METHODS We analyzed the prognostic significance of the initial CT regimen (4 vs. 7-8 drugs), treatment-free interval (TFI), and demographic, clinical, and laboratory factors at the time of relapse and diagnosis, in 113 patients with HL, who relapsed after a CR achieved by CT+/-RT. RESULTS Conventional salvage CT+/-RT was administered in 107 patients, while six received RT only. The 5-yr FF2P was 24%, while the 10-yr survival after relapse (O2S) was 39% and was not afffected by the initial CT regimen. Multivariate analysis revealed that extranodal disease at relapse (P<0.001), TFI<6 month (P<0.001), > or =5 involved sites at diagnosis (P=0.04) and anemia at relapse (P=0.03) were independent predictors of FF2P. 55% of patients had 0 or 1 of these adverse prognostic factors. The 5-yr FF2P of patients with 0, 1 or 2 adverse factors was 58%, 34% and 5% (P<0.0001). The corresponding rates for 10-yr O2S were 68%, 51% and 25%, respectively (P=0.002). CONCLUSIONS Our data confirmed the significance of TFI and extranodal relapse and demonstrated a potential role for anemia at relapse and number of involved sites at diagnosis, for the prognosis of patients with HL relapsing after CT+/-RT. The combination of these prognostic factors defines a sizeable subgroup of patients with favorable outcome following conventional salvage therapy.
Collapse
Affiliation(s)
- Theodoros P Vassilakopoulos
- Hematology Section, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 16 Sevastoupoleos Street, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
26
|
Angelopoulou MK, Siakantariz MP, Vassilakopoulos TP, Kontopidou FN, Rassidakis GZ, Dimopoulou MN, Kittas C, Pangalis GA. The splenic form of mantle cell lymphoma. Eur J Haematol 2002; 68:12-21. [PMID: 11952817 DOI: 10.1034/j.1600-0609.2002.00551.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe the clinical, immunophenotypic and molecular features, as well as the clinical course of patients with unusual presentation of mantle cell lymphoma (MCL) purely located to the spleen. PATIENTS AND METHODS We describe seven patients presented with splenomegaly and a leukemic picture without lymphadenopathy, fulfilling the diagnostic criteria of MCL. In addition to clinical and pathologic features, patients were studied with respect to surface immunophenotype, including adhesion molecule profile, immunohistochemical expression of cyclin-D1 and bcl-1 rearrangement by polymerase chain reaction. RESULTS Four patients were male and three female. The median palpable spleen size was 15 cm. A preliminary diagnosis of MCL was made, based on blood cell morphology and immunophenotype. All patients underwent splenectomy for therapeutic purposes. Studies done in blood and splenic lymphocytes revealed the following: 7/7 patients were CD19/CD5, CD20 and CD38 positive; CD10 negative and 6/7 CD23 negative. The adhesion molecule expression pattern was consistent in all patients: L-Selectin and CD11c were negative, CD11alpha and CD18 weakly positive and CD54 strongly positive. The median spleen weight was 1775 g. Histology disclosed a cytologic and architectural pattern consistent with MCL. Cyclin-D1 was positive in 6/6 studied patients. Bcl-1 rearrangement was found in 5/7 patients. Splenectomy was applied as the sole treatment and was beneficial in all patients, with median blood values as following: prior to splenectomy, Ht 29.5%, platelets 110 x 10(9)/l, lymphoma cells 5.0 x 10(9)/L, and at 6 months post-splenectomy, Ht 43%, platelets 311 x 10(9)/l and lymphoma cells 3.0 x 10(9)/L. Of the seven patients, two developed progressive disease 11 and 26 months post-splenectomy. The remaining five are in improving clinical and hematological condition without chemotherapy at a median follow up of 20 months. CONCLUSIONS We conclude that this presentation represents a separate form of MCL which requires splenectomy. It remains to be seen whether it carries a better prognosis than classical MCL.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Antigens, CD/analysis
- Antigens, Neoplasm/analysis
- Biomarkers, Tumor/analysis
- Blood Cell Count
- Bone Marrow/pathology
- Cell Adhesion Molecules/analysis
- Cyclin D1/analysis
- Disease Progression
- Female
- Follow-Up Studies
- Genes, bcl-1
- Humans
- Immunophenotyping
- Lymphocytes/chemistry
- Lymphocytes/pathology
- Lymphoma, Mantle-Cell/chemistry
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Mantle-Cell/surgery
- Male
- Middle Aged
- Neoplasm Proteins/analysis
- Neoplastic Stem Cells/chemistry
- Neoplastic Stem Cells/pathology
- Splenectomy
- Splenic Neoplasms/chemistry
- Splenic Neoplasms/diagnosis
- Splenic Neoplasms/genetics
- Splenic Neoplasms/pathology
- Splenic Neoplasms/surgery
- Splenomegaly/etiology
Collapse
Affiliation(s)
- Maria K Angelopoulou
- Hematology Section, First Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 16 Sevastoupoleos Street, 11510 Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
|
27
|
Kyrtsonis MC, Vassilakopoulos TP, Angelopoulou MK, Siakantaris P, Kontopidou FN, Dimopoulou MN, Boussiotis V, Gribabis A, Konstantopoulos K, Vaiopoulos GA, Fessas P, Kittas C, Pangalis GA. Waldenström's macroglobulinemia: clinical course and prognostic factors in 60 patients. Experience from a single hematology unit. Ann Hematol 2001; 80:722-7. [PMID: 11797112 DOI: 10.1007/s00277-001-0385-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2001] [Accepted: 09/09/2001] [Indexed: 11/25/2022]
Abstract
Waldenström's macroglobulinemia (WM) is a lymphoplasmacytic lymphoma characterized by the presence in patients' serum of an IgM monoclonal component. We report on our experience with 60 WM patients, focusing on their clinical findings, response to treatment, and the possible identification of prognostic factors. Of these patients, 70% presented with fatigue, and lymphadenopathy was observed in 22%, splenomegaly in 18%, hepatomegaly in 13%, and extranodal site of involvement in 6%. Bleeding tendency was seen in 17%, infections in 17%, hyperviscosity syndrome in 12%, and cardiac failure in 25% of the patients. The median of IgM levels was 30 g/l with hypoalbuminemia in 20% of cases, hypogammaglobulinemia in 27%, polyclonal hypergammaglobulinemia in 15%, kappa light-chain restriction in 78%, and Bence-Jones proteinuria in 54%. Anemia was frequent (85%), followed by leukocytosis (18%), lymphocytosis (12%), leukopenia (10%), and thrombocytopenia (10%). Cryoglobulinemia and autoimmune hemolytic anemia were encountered in 5%. In all cases but two, bone marrow was involved. Of 50 patients initially treated with intermittent oral chlorambucil, 46 (92%) responded. Median overall survival was 108 months. Factors associated with adverse prognosis were age > or =65 years (p=0.06), presence of lymphadenopathy (p=0.06), bone marrow infiltration > or =50% (p=0.007), international prognostic index (IPI) > or =3 (p=0.0001), and Morel's scoring system (p=0.04). Concluding, we found in this series of WM patients that chlorambucil is an effective treatment and that the parameters of age, lymphadenopathy, percentage of bone marrow infiltration, IPI, and Morel's scoring system carry prognostic significance.
Collapse
Affiliation(s)
- M C Kyrtsonis
- Hematology Section, First Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 16 Sevastoupoleos St., Athens 11526, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
28
|
Vassilakopoulos TP, Angelopoulou MK, Siakantaris MP, Kontopidou FN, Dimopoulou MN, Barbounis A, Grigorakis V, Karkantaris C, Anargyrou K, Chatziioannou M, Rombos J, Boussiotis VA, Vaiopoulos G, Kittas C, Pangalis GA. Prognostic factors in advanced stage Hodgkin's lymphoma: the significance of the number of involved anatomic sites. Eur J Haematol 2001; 67:279-88. [PMID: 11872075 DOI: 10.1034/j.1600-0609.2001.00561.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Advanced Hodgkin's lymphoma (HL) is curable by conventional chemotherapy in 60--70% of patients. The pretreatment identification of a sizeable subgroup of patients with sufficiently low failure-free survival (FFS) to be eligible for investigational treatment is necessary. OBJECTIVES To determine the prognostic significance of the number of involved sites (NIS) in patients with advanced HL and its relationship to the International Prognostic Score (IPS). METHODS A retrospective review of patients with advanced HL, defined as Ann Arbor stage (AAS) IB, IIB, III or IV, treated with anthracycline-based regimens. The end-point was FFS. RESULTS We identified 277 patients with a median age of 32 yr (14--78), 57% of whom were males. AAS was I in 4% of patients, II in 29%, III in 38% and IV in 29%. B-symptoms were recorded in 81%. Most patients had nodular sclerosis (64%) and mixed cellularity (26%) histology. IPS was greater-than-or-equals 3 in 44% of 242 evaluable patients. The NIS was greater-than-or-equals 5 in 32% of the patients and 20% of all patients had both greater-than-or-equals 5 involved sites and IPS greater-than-or-equals 3. The 10-yr FFS was 67%, being 76% vs. 50% for patients with less-than-or-equals 4 vs. greater-than-or-equals 5 involved sites (P < 0.0001). The NIS (greater-than-or-equal 5), AAS IV and anemia were independent predictors of FFS in multivariate analysis. The NIS remained significant along with IPS, when the latter was included in the analysis. Patients with greater-than-or-equals 5 involved sites and IPS greater-than-or-equals 3 had 10-yr FFS overall, and relapse-free survival of 41%, 45% and 49%, respectively. CONCLUSIONS The NIS was associated with FFS in advanced HL, was independent of IPS, and led to the identification of a sizeable subgroup of patients with 10-yr FFS of approximately 40%. This factor should be evaluated during the development of prognostic systems.
Collapse
Affiliation(s)
- T P Vassilakopoulos
- Hematology Section, First Department of Internal Medicine, National and Kapodistrian University, School of Medicine, Laikon General Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
29
|
Kyrtsonis MC, Angelopoulou MK, Kontopidou FN, Siakantaris MP, Dimopoulou MN, Mitropoulos F, Kalovidouris A, Vaiopoulos GA, Pangalis GA. Primary lung involvement in Waldenström's macroglobulinaemia: report of two cases and review of the literature. Acta Haematol 2001; 105:92-6. [PMID: 11408711 DOI: 10.1159/000046541] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pulmonary involvement in Waldenström's macroglobulinaemia (WM) occurs in 3-5% of cases, but lung involvement without bone marrow infiltration is extremely rare. We report 2 patients who presented with bilateral consolidations on chest X-ray and non-specific symptoms and were treated for a long period of time for pulmonary infections until the diagnosis was made by open lung biopsy. Both patients presented high monoclonal IgM in the serum and one also had blood lymphoplasmacytosis. Trephine bone biopsy and bone marrow smears were normal and there was no other site of involvement. Along with the presentation of our patients, we review the literature, discuss some of the possible underlying mechanisms and raise the attention of clinicians to this rare manifestation of the disease.
Collapse
Affiliation(s)
- M C Kyrtsonis
- Hematology Section, First Department of Internal Medicine, National and Kapodistrian University, School of Medicine, Laikon General Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|
|
30
|
Kyrtsonis MC, Kokoris SI, Kontopidou FN, Siakantaris MP, Kittas C, Pangalis GA. Development of a myeloproliferative disorder in a patient with monoclonal gammopathy of undetermined significance secreting immunoglobulin of the M class and treated with thalidomide and anti-CD20 monoclonal antibody. Blood 2001; 97:2527-8. [PMID: 11307775 DOI: 10.1182/blood.v97.8.2527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
|
31
|
Vassilakopoulos TP, Nadali G, Angelopoulou MK, Siakantaris MP, Dimopoulou MN, Kontopidou FN, Rassidakis GZ, Doussis-Anagnostopoulou IA, Hatzioannou M, Vaiopoulos G, Kittas C, Sarris AH, Pizzolo G, Pangalis GA. Serum interleukin-10 levels are an independent prognostic factor for patients with Hodgkin's lymphoma. Haematologica 2001; 86:274-81. [PMID: 11255274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Interleukin-10 (IL-10) is a pleiotropic cytokine which increases bcl-2 levels and protects cells from steroid or doxorubicin-induced apoptosis. Hodgkin and Reed-Sternberg (HRS) cells bear functional IL-10 receptors. Thus serum IL-10 (sIL-10) might inhibit apoptosis in HRS cells, which could occur as a result of either chemotherapy or the crippled immunoglobulin genes. DESIGN AND METHODS We determined sIL-10 levels in 122 patients with Hodgkin's lymphoma (HL), treated with ABVD or equivalent regimens with or without radiotherapy, and correlated them with presenting clinical and laboratory features, as well as failure-free survival (FFS) and overall survival. RESULTS Elevated sIL-10 levels ( > or = 10 pg/mL) were detected in 55 patients (45%), and were correlated with advanced stage and elevated serum b2-microglobulin levels. At 7 years FFS was 85% vs. 63% for patients with normal vs. elevated sIL-10 levels, respectively (p=0.01); overall survival was 97% vs. 73% (p=0.005). Multivariate analysis with Cox's proportional hazards model demonstrated that elevated sIL-10 levels were the strongest independent predictor of FFS, and were also associated with inferior overall survival. INTERPRETATION AND CONCLUSIONS We conclude that sIL-10 levels are elevated in 45% of patients with HL, and are associated with inferior FFS and overall survival, independently of other established prognostic factors.
Collapse
Affiliation(s)
- T P Vassilakopoulos
- Hematology Section, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
32
|
Korkolopoulou PA, Angelopoulou MK, Kontopidou FN, Patsouris EV, Christodoulou PN, Kittas CN, Davaris P, Pangalis GA. Retinoblastoma gene product and P21 (WAF1, CIP1) protein expression in non Hodgkin's lymphomas: a multivariate survival analysis. Leuk Lymphoma 2001; 40:647-58. [PMID: 11426536 DOI: 10.3109/10428190109097662] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We evaluated immunohistochemically the expression of two negative regulators of the cell cycle, namely retinoblastoma gene product (pRb) and WAF1/Cip1 gene product (p21), in paraffin sections from 93 patients with non-Hodgkin's lymphomas (NHL) and related it to clinicopathological parameters, proliferative fraction, p53 expression and survival. Patients were followed until death (n=33) or for an average of 52 months (60-160). Rb labelling index (LI) increased with malignancy grade and proliferative activity but was unrelated to other clinicopathological parameters. In 33% of cases, especially those of the aggressive groups, we observed diminished pRb expression (i.e. low pRb/Ki-67 ratio). p21 expression on the other hand correlated only with histological grade, Rb LI and p53 LI. In multivariate analysis, Rb LI was a negative predictor of disease-free survival but was linked to a higher probability of complete response. However, diminished pRb expression as well as p21 expression were not statistically significant prognostic indicators. Our results suggest that pRb as a cell cycle related molecule may play an important role in determining prognosis and therapeutic response in NHL patients.
Collapse
|
|
33
|
Siakantaris MP, Angelopoulou MK, Vassilakopoulos TP, Dimopoulou MN, Kontopidou FN, Pangalis GA. Correction of disease related anaemia of B-chronic lymphoproliferative disorders by recombinant human erythropoietin: maintenance is necessary to sustain response. Leuk Lymphoma 2000; 40:141-7. [PMID: 11426615 DOI: 10.3109/10428190009054891] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Thirty three B-chronic lymphoproliferative disorder (B-CLD) patients [22 with B-chronic lymphocytic leukemia (B-CLL), 5 with small lymphocytic lymphoma (SLL) and 6 with lymphoplasmacytic lymphoma (LPL)] with anaemia (Ht <32%) of no other cause but their disease, received recombinant human erythropoietin (r-HuEPO). The treatment protocol provided r-HuEPO in a dose of 150 U/kg s.c. thrice weekly for 3 mo. After 1.5 mo of r-HuEPO administration, if response was not satisfactory, r-HuEPO dose escalation was utilised by giving incremental doses of 50 U/kg more than the previous dose up to a maximum dose of 300 U/kg tiw. After maximal response, half of the responding patients discontinued therapy, while the other half received maintenance therapy at a dose of 150 U/kg s.c./w. Oral iron was given throughout the study. Pretreatment EPO levels were determined in all patients. A complete response (CR) was defined when Ht was >38% and a partial response (PR) when there was an increase of the Ht >6% from the initial value was achieved. Sixteen of the 22 B-CLL patients had Rai stage III disease and 6 stage IV, with a median duration of anaemia 27 months (6-38); twelve of them were receiving chlorambucil while the rest were on no treatment. Of the SLL and LPL group, 4 patients had Ann Arbor stage III disease and 7 stage IV with a median duration of anaemia 24 months (5-36); 8 patients were on chlorambucil. Complete response was achieved in 50% of the B-CLL group and 54% of the SLL and LPL group, with an overall response rate of 77% and 81% respectively. All patients on maintenance therapy had a continuous response, while all patients, in whom rHuEPO was discontinued, relapsed. No correlation was found between patients: with low or high pretreatment serum EPO levels; those receiving concomitant therapy or not; those with B-symptoms or not; those with a non-diffuse or diffuse bone marrow infiltration pattern; and with splenomegaly or not. Life quality was significantly improved and no major side effects were encountered. We conclude from our study that r-HuEPO is very effective in correcting disease-related anaemia in B-CLD, resulting in down-staging of Rai stage III patients and that maintenance therapy is necessary. Whether the correction of anaemia improves patients' overall survival, still remains to be seen.
Collapse
Affiliation(s)
- M P Siakantaris
- First Department of Internal Medicine, National and Kapodistrian University, School of Medicine, Laikon General Hospital, Athens, Greece
| | | | | | | | | | | |
Collapse
|
|
34
|
Angelopoulou MK, Vassilakopoulos TP, Siakantaris MP, Kontopidou FN, Boussiotis VA, Papavassiliou C, Kittas C, Pangalis GA. EBVD combination chemotherapy plus low dose involved field radiation is a highly effective treatment modality for early stage Hodgkin's disease. Leuk Lymphoma 2000; 37:131-43. [PMID: 10721777 DOI: 10.3109/10428190009057636] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To evaluate the efficacy of EBVD combination chemotherapy followed by low dose (LD) involved field (IF) radiation therapy (RT) in patients with clinical stage (CS) I-IIA Hodgkin's disease (HD), we analyzed 148 patients treated in our Unit from March 1988 to November 1995. EBVD consisted of Epirubicine 40 mg/m2, Bleomycin 10 mg/m2, Vinblastine 6 mg/m2 and Dacarbazine 300 mg. All drugs were administered i.v. at days 1 and 15, every 4 weeks, for a total of 4-6 cycles. LDIF RT (24-32 Gy) was scheduled for patients with complete response (CR) or >90% reduction of tumor load, after EBVD. Patients with stable or progressive disease (SD, PD) after EBVDx3 or poor compliance to the regimen received mantle or inverted Y RT at standard dose. The median follow-up of patients currently alive was 71.5 months. 129 patients achieved a CR after EBVD and 10 a >90% reduction of tumor load, for a post-CT response rate of 94%. Eight patients had SD after EBVDx3 and one had a partial response with poor compliance. All 9 patients received mantle or inverted Y RT and 8/9 achieved a CR. Nine patients relapsed at a median of 7 months from the end of treatment. At 10 years, FFS was 90% and overall survival 95%. Six patients have died so far; 5 of HD and one of stroke. One patient developed a diffuse large cell lymphoma 48 months after the diagnosis of HD. We conclude that EBVD followed by LDIF RT is a highly effective regimen for patients with CS I-IIA HD. Longer follow up is required to assess the risk of secondary malignancies, especially solid tumors.
Collapse
Affiliation(s)
- M K Angelopoulou
- National and Kapodistrian University of Athens, First Department of Internal Medicine, Laikon General Hospital, Greece
| | | | | | | | | | | | | | | |
Collapse
|
|
35
|
Angelopoulou MK, Kontopidou FN, Pangalis GA. Adhesion molecules in B-chronic lymphoproliferative disorders. Semin Hematol 1999; 36:178-97. [PMID: 10319387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
In B-chronic lymphoproliferative disorders (B-CLD) adhesion molecules (AM) have been investigated in order to explain the variable biologic behavior and dissemination patterns and to assess their contribution to the differential diagnosis and prognosis of these diseases. The main AM studied either by immunohistochemistry on lymph node sections or by flow cytometry in blood and bone marrow specimens are L-selectin, CD11a/CD18 (LFA-1), CD54 (ICAM-1), CD44 (HCAM), CD11c/CD18 (gp150/95), and CD49d/CD29 (VLA-4). Among B-CLD, hairy-cell leukemia (HCL) and follicular lymphoma (FL) show a uniform AM expression pattern. Thus, HCL is characterized by high CD54, CD44, VLA-4, CD11c, and CD18 and by low or absent CD11a and L-selectin, whereas FL confined to the lymph nodes is characterized by high CD11a, CD18, and CD54 expression. Diffuse growth and dissemination of FL is associated with alteration in the AM profile. Mantle-cell lymphoma (MCL) seems to be characterized by low or absent L-selectin and CD11c and high CD54 expression, especially compared with B-chronic lymphocytic leukemia (B-CLL). B-CLL is the most heterogeneous among all B-CLD with respect to AM expression. In general, low LFA-1 and CD54, high L-selectin and CD44, and variable CD11c characterize B-CLL. Cases with splenomegaly as their prominent feature bear high CD11a, CD18, CD29, and CD11c on the surface of the leukemic cells. Small lymphocytic lymphoma (SLL) shares the same AM phenotype with B-CLL, with the possible exception of LFA-1, which is strongly expressed on SLL cells. LFA-1 and CD54 are more frequently positive in lymphoplasmacytic lymphoma (LPL) as compared with B-CLL. Splenic lymphoma with villous lymphocytes differs from B-CLL by its high LFA-1, VLA-4, and CD54 and low L-selectin expression, whereas its high LFA-1 positivity can differentiate it from HCL. Surface and soluble AM have been investigated as possible prognostic markers in these diseases. Conflicting data exist concerning the prognostic significance of surface AM. However, high soluble (s)CD44 and CD54 levels in B-CLL and non-Hodgkin's lymphomas (NHL) are considered as adverse prognostic factors.
Collapse
Affiliation(s)
- M K Angelopoulou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Greece
| | | | | |
Collapse
|